title: Increased risk of atrial fibrillation and stroke during active stages of inflammatory bowel disease: a nationwide study.
abstract: OBJECTIVE
  Inflammation is considered to play a role in the development of atrial fibrillation (AF). Hence inflammatory bowel disease (IBD) may be associated with AF. We therefore examined the incidence of AF and stroke in patients with IBD.
  
  
  RESULTS
  From Danish nationwide registries 1996-2011, we identified 24 499 patients with new-onset IBD and 236 275 age- and sex-matched controls. Poisson regression analyses with continuously updated covariates were used to estimate incidence rate ratios (IRRs) of AF and stroke. Disease activity stages of flare (new disease activity), persistent activity, and remission were defined by corticosteroid prescriptions, IBD hospital admissions, and biological treatment. Inflammatory bowel disease patients had a mean age of 43.9 years, 53.9% were women, and mean follow-up was 6.8 years. Among IBD patients, 685 had AF and 549 had a stroke, corresponding to incidence rates per 1000 person-years of 4.16 vs. 2.70 for AF and 3.33 vs. 2.44 for stroke, compared with matched controls. Overall IBD-associated risk of AF corresponded to IRR 1.26 (1.16-1.36), but was driven by increased AF incidence during IBD flares [IRR 2.63 (2.26-3.06)] and persistent activity [IRR 2.06 (1.67-2.55)], whereas no increased AF risk was observed in remission periods [IRR 0.97 (0.88-1.08)]. Likewise increased stroke risk was exclusively found during active IBD [IRRs: 1.57 (1.27-1.93), 1.71 (1.32-2.21), and 1.04 (0.93-1.15) for flares, persistent activity, and remission, respectively].
  
  
  CONCLUSIONS
  Active IBD is associated with increased risk of AF and stroke. These findings may be relevant to clinical practice.
authors.affiliation: Department of Cardiology-Post 635, Copenhagen University Hospital Gentofte, Niels Andersens Vej 65, 2900 Hellerup, Denmark.
authors.forename: Søren Lund
authors.initials: SL
authors.lastname: Kristensen
authors.forename: Jesper
authors.initials: J
authors.lastname: Lindhardsen
authors.forename: Ole
authors.initials: O
authors.lastname: Ahlehoff
authors.forename: Rune
authors.initials: R
authors.lastname: Erichsen
authors.forename: Morten
authors.initials: M
authors.lastname: Lamberts
authors.forename: Usman
authors.initials: U
authors.lastname: Khalid
authors.forename: Christian
authors.initials: C
authors.lastname: Torp-Pedersen
authors.forename: Ole Haagen
authors.initials: OH
authors.lastname: Nielsen
authors.forename: Gunnar Hilmar
authors.initials: GH
authors.lastname: Gislason
authors.forename: Peter Riis
authors.initials: PR
authors.lastname: Hansen
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000453:epidemiology*; D001688:Biological Products / Q000627:therapeutic use; D016022:Case-Control Studies; D003093:Colitis, Ulcerative / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D003424:Crohn Disease / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D003718:Denmark / Q000453:epidemiology; D018450:Disease Progression; D005260:Female; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012042:Registries; D012074:Remission Induction; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D001688:Biological Products
keywords: Atrial fibrillation; Crohn's disease; Stroke; Ulcerative colitis